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Goal-directed intraoperative fluid therapy improved postoperative renal functions in aortic surgical patients

Introduction

Goal-directed intraoperative fluid therapy reduced the hospital stay after major surgery [1]. Aortic vascular surgery is associated with excessive blood loss and massive fluid shift [2]. We found that postoperative urea and creatinine improved when intravascular fluid volume was maintained using transoesophageal Doppler.

Methods

We randomly selected 40 patients who underwent elective infrarenal aortic surgery (aortic aneurysm repair/aortobifemoral grafting). All patients' cardiac output was continuously monitored using a transoesophageal Doppler probe (EDM™; Deltex Medical, Inc., Irving, TX, USA). The corrected flow time (FTc) was recorded immediately after induction as a baseline and recorded again pre-extubation. A target FTc of 375–425 ms was aimed for. The estimated total blood loss was calculated for each patient at the end of surgery. Preoperative and 24-hour postoperative urea and creatinine were recorded for comparison.

Results

The mean baseline FTc was 278 ms, and the mean target FTc was 405 ms. The mean average blood loss was 3.77 l/patient. The mean preoperative urea and creatinine were 5.9 mmol/l and 95.3 mmol/l, respectively. The mean 24-hour postoperative urea and creatinine were 5.23 mmol/l and 76.77 mmol/l, respectively. See Figure 1.

figure1

Figure 1

Conclusion

Goal-directed intraoperative fluid therapy aiming for FTc of 375–425 ms as a target improved the 24-hour postoperative urea urea and creatinine in 40 aortic surgical patients in spite of the excessive blood loss.

References

  1. 1.

    Gan , et al.: Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002, 97: 820-826. 10.1097/00000542-200210000-00012

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  2. 2.

    Miyashita T, et al.: An analysis of risk factors of perioperative bleeding in surgical repair of abdominal aortic aneurysm. J Cardiovasc Surg 2000, 41: 595-599.

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Soliman, M., Bajaj, S. & Ismail, K. Goal-directed intraoperative fluid therapy improved postoperative renal functions in aortic surgical patients. Crit Care 11, P312 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5472

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Keywords

  • Creatinine
  • Aortic Aneurysm
  • Fluid Shift
  • Total Blood Loss
  • Doppler Probe